STATUTORY DECLARATION I

STATUTORY DECLARATIONI, ______________________________________________ (Name as in NRIC/FIN) ofNRIC/FIN No. ______________ of _________________________________________(Address), do solemnly and sincerely declare that:-1 I facilitated the lawful transfer of the custody of the child named_______________________________________________________ (original name)of foreign passport / birth certificate No____________________ from his/her biologicalparents in ______________ (country) for adoption by the Applicants (prospectiveadoptive parents), ___________________________________ (Name as in NRIC/FIN)of NRIC/FIN No. ______________, and _______________________________(Name as in NRIC/FIN) of NRIC/FIN No. _______________, both of_____________________________________________________________ (Address)in Originating Summons No _______of __________filed in the Subordinate Courts ofSingapore on______________.[version A of para 2 for those who have seen the biological parents]2A I declare that the biological parents of the said child before transferring thecustody of the child of their own free will had fully understood the nature and effect ofthe adoption process in Singapore and have consented to the child being adopted bythe Applicants in accordance with the laws of Singapore.[version B of para 2 for those who have facilitated a child from an orphanage]2B I declare that I have seen the written consent of the biological parents of thechild in which they had expressly declared that they had willingly given custody of thechild to _______________________________________________ (name of theorphanage) for adoption in accordance with the laws of Singapore and they had fullyunderstood the legal effect of an adoption order made by a Singapore court.3 In procuring the custody and possession of the child for the purpose ofadoption, I have not, nor have I any reason to believe that I have in any way directly orindirectly:

(a) been involved in any abduction, kidnapping, trafficking or any criminal act ofor involving the child either within or outside Singapore;(b) participated knowingly in any unlawful transfer of possession, custody orcontrol of the child either within or outside Singapore;(c) been involved knowingly in the procurement or use of any fraudulent orforged passport or any other relevant document for the purpose of bringingthe child into Singapore; and/or(d) committed knowingly an offence under the laws of Singapore in connectionwith the adoption proceedings.4 I have been advised and am fully aware that if I have been in any way directlyor indirectly knowingly involved in any one or more of the acts specified in paragraph 3above, I am liable to be prosecuted under the Children and Young Persons Act (Cap38), the Kidnapping Act (Cap 151), the Penal Code (Cap 224), the Prevention ofCorruption Act (Cap 241), the Women’s Charter (Cap 353) and/or any other relevantlaws in force in Singapore at the time of the commission of the aforesaid act(s).And I make this solemn declaration by virtue of the provisions of the Oaths andDeclarations Act (Cap. 211), and subject to the penalties provided by that Act forthe making of false statements in statutory declarations, conscientiouslybelieving the statements contained in this declaration to be true in everyparticular.Name and Signature of DeclarantDeclared at Singapore this day of 20___.Before me,Notary Public or Commissioner for Oaths